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Marley G, Annis IE, Ostrach B, Egan K, Delamater PL, Bell R, Dasgupta N, Carpenter DM. Naloxone Accessibility by Standing Order in North Carolina Community Pharmacies. J Am Pharm Assoc (2003) 2024; 64:102021. [PMID: 38307248 PMCID: PMC11081860 DOI: 10.1016/j.japh.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND According to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription. OBJECTIVE The objective of this study is to examine whether same-day naloxone accessibility and cost vary by pharmacy type and rurality in NC. METHODS A cross-sectional telephone audit of 202 NC community pharmacies stratified by pharmacy type and county of origin was conducted in March and April 2023. Trained "secret shoppers" enacted a standardized script and recorded whether naloxone was available and its cost. We examined the relationship between out-of-pocket naloxone cost, pharmacy type, and rurality. RESULTS Naloxone could be purchased in 53% of the pharmacies contacted; 26% incorrectly noting that naloxone could be filled only with a provider prescription and 21% did not sell naloxone. Naloxone availability by standing order was statistically different by pharmacy type (chain/independent) (χ2 = 20.58, df = 4, P value < 0.001), with a higher frequency of willingness to dispense according to the standing order by chain pharmacies in comparison to independent pharmacies. The average quoted cost for naloxone nasal spray at chain pharmacies was $84.69; the cost was significantly more ($113.54; P < 0.001) at independent pharmacies. Naloxone cost did not significantly differ by pharmacy rurality (F2,136 = 2.38, P = 0.10). CONCLUSION Approximately half of NC community pharmacies audited dispense naloxone according to the statewide standing order, limiting same-day access to this life-saving medication. Costs were higher at independent pharmacies, which could be due to store-level policies. Future studies should further investigate these cost differences, especially as intranasal naloxone transitions from a prescription only to over-the-counter product.
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Affiliation(s)
- Grace Marley
- Grace T. Marley, PharmD, UNC Eshelman School of Pharmacy 201 Pharmacy Lane, CB 7355, Chapel Hill, NC 27599-7355, USA
| | - Izabela E Annis
- Izabela E Annis, MS, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC 27599
| | - Bayla Ostrach
- Bayla Ostrach PhD, MA CIP, Medical Anthropology & Family Medicine, Boston University School of Medicine; Fruit of Labor Action Research & Technical Assistance, LLC, 608 Emmas Grove Rd., Fletcher, NC 28732
| | - Kathleen Egan
- Kathleen L Egan PhD, MS, Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine
| | - Paul L. Delamater
- Paul Delamater PhD, Department of Geography and Environment, University of North Carolina at Chapel Hill
| | - Ronny Bell
- Ronny Bell, PhD, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 27599
| | - Nabarun Dasgupta
- Nabarun Dasgupta, MPH, PhD, Injury Prevention Research Center, 725 MLK Jr. Blvd, CB 7505, Chapel Hill, NC 27599
| | - Delesha M. Carpenter
- Delesha M. Carpenter MSPH, PhD, UNC Eshelman School of Pharmacy 220 Campus Drive CPO 2125 Asheville, NC 28804
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Hodson N, Powell BJ, Nilsen P, Beidas RS. How can a behavioral economics lens contribute to implementation science? Implement Sci 2024; 19:33. [PMID: 38671508 PMCID: PMC11046816 DOI: 10.1186/s13012-024-01362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Implementation science in health is an interdisciplinary field with an emphasis on supporting behavior change required when clinicians and other actors implement evidence-based practices within organizational constraints. Behavioral economics has emerged in parallel and works towards developing realistic models of how humans behave and categorizes a wide range of features of choices that can influence behavior. We argue that implementation science can be enhanced by the incorporation of approaches from behavioral economics. Main body First, we provide a general overview of implementation science and ways in which implementation science has been limited to date. Second, we review principles of behavioral economics and describe how concepts from BE have been successfully applied to healthcare including nudges deployed in the electronic health record. For example, de-implementation of low-value prescribing has been supported by changing the default in the electronic health record. We then describe what a behavioral economics lens offers to existing implementation science theories, models and frameworks, including rich and realistic models of human behavior, additional research methods such as pre-mortems and behavioral design, and low-cost and scalable implementation strategies. We argue that insights from behavioral economics can guide the design of implementation strategies and the interpretation of implementation studies. Key objections to incorporating behavioral economics are addressed, including concerns about sustainment and at what level the strategies work. CONCLUSION Scholars should consider augmenting implementation science theories, models, and frameworks with relevant insights from behavioral economics. By drawing on these additional insights, implementation scientists have the potential to boost efforts to expand the provision and availability of high quality care.
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Affiliation(s)
- Nathan Hodson
- Price School of Public Policy, University of Southern California, Los Angeles, USA.
- Warwick Medical School, Unit of Mental Health and Wellbeing, Division of Health Sciences, University of Warwick, Coventry, UK.
- Department of Medical Social Sciences, Feinberg School of Medicine Northwestern University, Chicago, USA.
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Per Nilsen
- Department of Health, Medicine, and Caring Sciences (HMV), Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine Northwestern University, Chicago, USA
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Chicago, USA
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Pless V, McClure J, Davis M, Farfalla J, Onufrey Y, Humm K, Ranade R, Terzian M. Reducing Overdose Through Policy Interventions: ASTHO's Recommendations for State and Territorial Health Officials and Agencies. J Public Health Manag Pract 2023; 29:748-752. [PMID: 37478096 DOI: 10.1097/phh.0000000000001799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Victoria Pless
- Association of State and Territorial Health Officials, Arlington, Virginia
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Gallant TL, Gilbert AR, Zargham S, Lorenzo MFD, Puglisi JL, Nicholas ZR, Gerriets VA. Impact of California Statute on Naloxone Availability and Opioid Overdose Rates. AJPM Focus 2023; 2:100112. [PMID: 37790675 PMCID: PMC10546523 DOI: 10.1016/j.focus.2023.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Ensuring that people at risk of overdosing on opioids have easy access to naloxone is an essential part of the fight against the opioid crisis. This study evaluates the impact of the 2016 California law (CA AB1535) permitting pharmacies to dispense this life-saving medication without a physician's prescription. Methods California counties were categorized on the basis of population density (rural, suburban, urban), rate of opioid-related deaths by population density (high, medium, low), and rate of opioid prescriptions by population density (high, medium, low). Ten diverse pharmacies from each category were selected for inclusion. In a brief 1-minute interview conducted between July and August 2021, pharmacists from 146 California pharmacies were surveyed regarding their knowledge of CA AB1535, their practice of dispensing naloxone without a physician's prescription, and whether they normally stock naloxone. Chi-square tests were used to compare responses. Results Although almost all pharmacies interviewed (94%) were aware of the law and most of them (64%) dispensed naloxone without a physician's prescription, few statistically significant differences were found between surveyed categories. There were no significant relationships between naloxone availability at pharmacies and overdose death rates. Conclusions Our results suggest that the number of California pharmacies dispensing naloxone without a physician's prescription has continued to increase since the implementation of CA AB1535. However, despite increased access to naloxone at pharmacies, opioid overdose rates have continued to rise since 2016, indicating the need for a multifaceted harm reduction approach.
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Affiliation(s)
- Tara L. Gallant
- Department of Basic Science, California Northstate University College of Medicine, Elk Grove, California
| | - Andrew R. Gilbert
- Department of Basic Science, California Northstate University College of Medicine, Elk Grove, California
| | - Sina Zargham
- Department of Basic Science, California Northstate University College of Medicine, Elk Grove, California
| | - Michael F. Di Lorenzo
- Department of Basic Science, California Northstate University College of Medicine, Elk Grove, California
| | - Jose L. Puglisi
- Department of Basic Science, California Northstate University College of Medicine, Elk Grove, California
| | - Zachary R. Nicholas
- Department of Basic Science, California Northstate University College of Medicine, Elk Grove, California
| | - Valerie A. Gerriets
- Department of Basic Science, California Northstate University College of Medicine, Elk Grove, California
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5
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Incze MA, Kelley AT, Singer PM. Implementing the White House's Strategic Plan to Save Lives Amid the Opioid Crisis: Reaching for the "North Star". JAMA 2023; 329:705-706. [PMID: 36745436 DOI: 10.1001/jama.2023.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This Viewpoint discusses the goals of the inaugural National Drug Control Strategy, which as the ambitious agenda of emphasizing harm reduction practices, medications for treating opioid use disorder, and criminal justice reform, as well as supporting long-term recovery and interrupting illicit drug trafficking.
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Affiliation(s)
- Michael A Incze
- Division of General Internal Medicine, University of Utah, Salt Lake City
- PARCKA, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - A Taylor Kelley
- PARCKA, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
- Vulnerable Veteran Innovative Patient Aligned Care Team Initiative, IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Phillip M Singer
- Department of Political Science, University of Utah, Salt Lake City
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Banawis M, Mah G, Mohsin R, Pobre J, Tracy D, Song AV, Apollonio DE. An observational study of the extent of naloxone furnishing in California Central Valley community pharmacies. J Am Pharm Assoc (2003) 2022. [PMID: 36476261 DOI: 10.1016/j.japh.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND California has sought to expand medication access and improve public health by authorizing pharmacists in California to prescribe certain medications since 2014. Medications with pharmacist-initiated prescribing, or furnishing, include naloxone, hormonal contraception, postexposure prophylaxis/preexposure prophylaxis, and nicotine replacement therapy. In light of the United States' opioid epidemic, naloxone, an opioid antagonist, this study considered furnishing rates in urban areas of California. Research from 2020 found 42.5% of pharmacies furnished naloxone. However, there has been limited study of furnishing outside of urban areas. OBJECTIVE This study assessed pharmacist furnishing rates of naloxone in California's Central Valley and identified barriers and facilitators to implementation. METHODS From April to May 2022, the researchers first conducted a cross-sectional, observational study of community and mail-order pharmacies in California's largely rural Central Valley, then collected interview data from a subset of pharmacists in stores that indicated they furnished naloxone. RESULTS Forty-three percent of Central Valley pharmacies reported that they furnished naloxone. Interview respondents reported that barriers to furnishing included time restrictions, cost to patients, stigma, and language barriers. CONCLUSIONS Furnishing rates in the Central Valley were slightly higher (43.4%) than those reported in previous research focusing on urban areas of California (42.5%). Identified barriers to furnishing were consistent with those identified in previous research. These findings suggest that further policy interventions may be needed to reduce out-of-pocket costs, establish stronger pharmacist-provider relationships, and provide education combatting stigma against opioid users to increase naloxone furnishing.
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Atkinson J. Advances in Pharmacy Practice: A Look towards the Future. Pharmacy (Basel) 2022; 10:125. [PMID: 36287446 DOI: 10.3390/pharmacy10050125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
This review looks at the factors that may influence practice in the future. Transformation could occur at 3 levels. Firstly, the traditional profession of the pharmacist as a dispenser of medicines is expanding. Secondly, the pharmacist’s activities are progressing into new healthcare fields. Thirdly, other changes are stimulated by global developments. This review may be helpful for pharmacy and healthcare leaders looking at the future configuration and aims of their pharmacy services.
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8
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Houser R. Expanding Access to Naloxone: A Necessary Step to Curb the Opioid Epidemic. Disaster Med Public Health Prep 2022; 17:e245. [PMID: 36172901 DOI: 10.1017/dmp.2022.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The COVID-19 Pandemic has exacerbated the already worsening opioid epidemic within the United States. With a continuing increase in opioid overdose deaths, measures are needed to halt the needless number of deaths and begin on a path of recovery to address all the factors that impact the epidemic. The CDC has provided various recommendations to combat the increases in opioid overdose deaths. These recommendations have included expanded distribution and use of naloxone and overdose prevention education as essential services for people most at risk of overdose. While strategies should include the increase in community resources for those with opioid disorder and shifting the perspectives of healthcare to view opioid disorder as a chronic illness that can be treated with medication such as buprenorphine, these methods are not immediate enough to stop the trend in deaths. The United States must take immediate action to expand access to and use of Naloxone for the public and first responders. Naloxone alone cannot address the magnitude of this epidemic, but it is an essential first step in preventing immediate death while a multimodal strategy is enacted to fully protect those most at risk.
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Hill LG, Loera LJ, Torrez SB, Puzantian T, Evoy KE, Ventricelli DJ, Eukel HN, Peckham AM, Chen C, Ganetsky VS, Yeung MS, Zagorski CM, Reveles KR. Availability of buprenorphine/naloxone films and naloxone nasal spray in community pharmacies in 11 U.S. states. Drug Alcohol Depend 2022; 237:109518. [PMID: 35691255 DOI: 10.1016/j.drugalcdep.2022.109518] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prompt access to prescribed buprenorphine/naloxone films (BUP/NX) and naloxone nasal spray (NNS) is vital for patients with opioid use disorder (OUD), but multiple studies have documented pharmacy-level barriers. METHODS A cross-sectional secret shopper telephone audit was conducted in a sample of 5734 actively licensed pharmacies in 11 U.S. states from May 2020-April 2021. Primary outcomes included availability of 14 generic BUP/NX 8/2 mg and one unit of NNS 4 mg. Outcomes were compared by pharmacy type, county metropolitan status, state Medicaid expansion status, and state drug overdose death rate. RESULTS Data from 4984 pharmacies (3402 chain and 1582 independent) were analyzed. Both medications were available in 41.2 % of pharmacies, BUP/NX was available in 48.3%, and NNS was available in 69.5%. Chain pharmacies were significantly more likely than independent pharmacies to have both medications available, to have each medication available individually, and to be willing to order BUP/NX. Pharmacies in metropolitan counties were more likely to have BUP/NX available than pharmacies in non-metropolitan counties, pharmacies in Medicaid expansion states were more likely to have both medications available and to have NNS available than pharmacies in non-expansion states, and pharmacies in states with high drug overdose death rates were more likely to have NNS available than pharmacies in states with low drug overdose death rates. CONCLUSIONS BUP/NX and NNS are not readily accessible in many U.S. pharmacies. Deficits in access are most pronounced in independent pharmacies, though county- and state-level factors may also influence availability of these essential medications.
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Dahlem CH, Myers M, Goldstick J, Stevenson JG, Gray G, Rockhill S, Dora-Laskey A, Kellenberg J, Brummett CM, Kocher KE. Factors associated with naloxone availability and dispensing through Michigan's pharmacy standing order. Am J Drug Alcohol Abuse 2022; 48:454-463. [PMID: 35405078 DOI: 10.1080/00952990.2022.2047714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
Background: Pharmacy standing order policies allow pharmacists to dispense naloxone, thereby increasing access to naloxone. Objectives: To describe pharmacy standing order participation and associations of pharmacy and community characteristics that predict naloxone availability and dispensing across eight counties in Michigan. Methods: We conducted a telephone survey of 662 standing order pharmacies with a response rate of 81% (n = 539). Pharmacies were linked with census tract-level demographics, overdose fatality rates, and dispensing data. County maps were created to visualize pharmacy locations relative to fatality rates. Regression models analyzed associations between pharmacy type, neighborhood characteristics, fatality rates, and these outcomes: naloxone availability, having ever dispensed naloxone, and counts of naloxone dispensed. Results: The prevalence of standing order pharmacies was 54% (n = 662/1231). Maps revealed areas with higher fatality rates had fewer pharmacies participating in the standing order or lacked any pharmacy access. Among standing order pharmacies surveyed, 85% (n = 458/539) had naloxone available and 82% had ever dispensed (n = 333/406). The mean out-of-pocket cost of Narcan® was $127.77 (SD: 23.93). National chains were more likely than regional chains to stock naloxone (AOR = 3.75, 95%CI = 1.77, 7.93) and to have ever dispensed naloxone (AOR 3.02, 95%CI = 1.21,7.57). Higher volume of naloxone dispensed was associated in neighborhoods with greater proportions of public health insurance (IRR = 1.38, 95%CI = 1.21, 1.58) and populations under 44 years old (IRR = 1.24, 95%CI = 1.04, 1.48). There was no association with neighborhood overdose fatality rates or race in regression models. Conclusion: As deaths from the opioid epidemic continue to escalate, efforts to expand naloxone access through greater standing order pharmacy participation are warranted.
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Affiliation(s)
- Chin Hwa Dahlem
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Myers
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jason Goldstick
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - James G Stevenson
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - George Gray
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Sarah Rockhill
- Division of Environmental Health, Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Aaron Dora-Laskey
- Department of Emergency Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Joan Kellenberg
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Keith E Kocher
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Lai RK, Friedson KE, Reveles KR, Bhakta K, Gonzales G, Hill LG, Evoy KE. Naloxone Accessibility Without an Outside Prescription from U.S. Community Pharmacies: A Systematic Review. J Am Pharm Assoc (2003) 2022; 62:1725-1740. [DOI: 10.1016/j.japh.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
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Benzon HT, Sun EC, Chou R. The Opioid Crisis, Centers for Disease Control Opioid Guideline, and Naloxone Coprescription for Patients at Risk for Opioid Overdose. Anesth Analg 2022; 135:21-25. [PMID: 35709441 DOI: 10.1213/ane.0000000000006029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Honorio T Benzon
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric C Sun
- Departments of Anesthesiology, Perioperative and Pain Medicine.,Health Policy, Stanford University Medical School, Palo Alto, California
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, Oregon
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Dadiomov D, Bolshakova M, Mikhaeilyan M, Trotzky-Sirr R. Buprenorphine and naloxone access in pharmacies within high overdose areas of Los Angeles during the COVID-19 pandemic. Harm Reduct J 2022; 19:69. [PMID: 35768817 PMCID: PMC9241266 DOI: 10.1186/s12954-022-00651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Buprenorphine and naloxone are first-line medications for people who use opioids (PWUO). Buprenorphine can reduce opioid use and cravings, help withdrawal symptoms, and reduce risk of opioid overdose. Naloxone is a life-saving medication that can be administered to reverse an opioid overdose. Despite the utility of these medications, PWUO face barriers to access these medications. Downtown Los Angeles has high rates, and number, of opioid overdoses which could potentially be reduced by increasing distribution of naloxone and buprenorphine. This study aimed to determine the accessibility of these medications in a major urban city by surveying community pharmacies regarding availability of buprenorphine and naloxone, and ability to dispense naloxone without a prescription. Methods Pharmacies were identified in the Los Angeles downtown area by internet search and consultation with clinicians. Phone calls were made to pharmacies at two separate time points–September 2020 and March 2021 to ask about availability of buprenorphine and naloxone. Results were collected and analyzed to determine percentage of pharmacies that had buprenorphine and/or naloxone in stock, and were able to dispense naloxone without a prescription. Results Out of the 14 pharmacies identified in the downtown LA zip codes, 13 (92.9%) were able to be reached at either time point. The zip code with one of the highest rates of opioid-related overdose deaths did not have any pharmacies in the area. Most of the pharmacies were chain stores (69.2%). Eight of the 13 (61.5%) pharmacies were stocked and prepared to dispense buprenorphine upon receiving a prescription, and an equivalent number was prepared to dispense naloxone upon patient request, even without a naloxone prescription. All of the independent pharmacies did not have either buprenorphine or naloxone available. Conclusions There is a large gap in care for pharmacies in high overdose urban zip codes to provide access to medications for PWUO. Unavailability of medication at the pharmacy-level may impede PWUO ability to start or maintain pharmacotherapy treatment. Pharmacies should be incentivized to stock buprenorphine and naloxone and encourage training of pharmacists in harm reduction practices for people who use opioids.
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Affiliation(s)
- David Dadiomov
- University of Southern California School of Pharmacy, 1985 Zonal Ave, Los Angeles, CACA, 90089, USA.
| | - Maria Bolshakova
- University of Southern California School of Pharmacy, 1985 Zonal Ave, Los Angeles, CACA, 90089, USA
| | - Melania Mikhaeilyan
- University of Southern California School of Pharmacy, 1985 Zonal Ave, Los Angeles, CACA, 90089, USA
| | - Rebecca Trotzky-Sirr
- University of Southern California School of Pharmacy, 1985 Zonal Ave, Los Angeles, CACA, 90089, USA
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14
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Egan KL, Johnston CA, Jackson JT, Foster SE, Lee JG. Rates and correlates of medicine disposal program implementation at pharmacies in North Carolina: A longitudinal study, 2016 to 2021. J Am Pharm Assoc (2003) 2022; 62:1329-1337. [DOI: 10.1016/j.japh.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
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15
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Smart R, Grant S. Effectiveness and implementability of state-level naloxone access policies: Expert consensus from an online modified-Delphi process. Int J Drug Policy 2021; 98:103383. [PMID: 34340167 PMCID: PMC8671224 DOI: 10.1016/j.drugpo.2021.103383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Naloxone distribution, a key global strategy to prevent fatal opioid overdose, has been a recent target of legislation in the U.S., but there is insufficient empirical evidence from causal inference methods to identify which components of these policies successfully reduce opioid-related harms. This study aimed to examine expert consensus on the effectiveness and implementability of various state-level naloxone policies. METHODS We used the online ExpertLens platform to conduct a three-round modified-Delphi process with a purposive sample of 46 key stakeholders (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with naloxone policy expertise. The Effectiveness Panel (n = 24) rated average effects of 15 types of policies on naloxone pharmacy distribution, opioid use disorder (OUD) prevalence, nonfatal opioid-related overdoses, and opioid-related overdose mortality. The Implementation Panel (n = 22) rated the same policies on acceptability, feasibility, affordability, and equitability. We compared ratings across policies using medians and inter-percentile ranges, with consensus measured using the RAND/UCLA Appropriateness Method Inter-Percentile Range Adjusted for Symmetry technique. RESULTS Experts reached consensus on all items. Except for liability protections and required provision of education or training, experts perceived all policies to generate moderate-to-large increases in naloxone pharmacy distribution. However, only three policies were expected to yield substantive decreases on fatal overdose: statewide standing/protocol order, over-the-counter supply, and statewide "free naloxone." Of these, experts rated only statewide standing/protocol orders as highly affordable and equitable, and unlikely to generate meaningful population-level effects on OUD or nonfatal opioid-related overdose. Across all policies, experts rated naloxone prescribing mandates relatively lower in acceptability, feasibility, affordability, and equitability. CONCLUSION Experts believe statewide standing/protocol orders are an effective, implementable, and equitable policy for addressing opioid-related overdose mortality. While experts believe many other broad policies are effective in reducing opioid-related harms, they also believe these policies face implementation challenges related to cost and reaching vulnerable populations.
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Affiliation(s)
- Rosanna Smart
- Economics, Sociology, and Statistics Department, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
| | - Sean Grant
- Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, IN 46202, USA
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Gilbert L, Elliott J, Beasley L, Oranu E, Roth K, Nguyễn J. Naloxone availability in independent community pharmacies in Georgia, 2019. Subst Abuse Treat Prev Policy 2021; 16:63. [PMID: 34419089 PMCID: PMC8379837 DOI: 10.1186/s13011-021-00402-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing the availability of naloxone among people who use opioids, and friends and family of past and present people who use opioids is a vitally important mission to reduce the occurrence of opioid-related overdose deaths. The purpose of this study was to determine the availability of naloxone in independent community pharmacies in Georgia. Secondary objectives include determining pharmacists' knowledge regarding the standing order and ability to counsel regarding naloxone. METHODS A cross-sectional study using a secret shopper approach with phone contact was conducted over a period of 10 months. The study was population based and was conducted at all independent pharmacies in the state of Georgia. All independent community pharmacies in the state of Georgia were contacted and asked the naloxone questions with a 96% response rate (n = 520). RESULTS Five hundred fifty-eight independent community pharmacies were called, with a 96% response rate (n = 520 pharmacies). Two hundred-twenty pharmacies reported having naloxone in stock. Of the 335 pharmacists asked, 174 (51.9%) incorrectly said that a prescription was required. The mean (SD) cash price was $148.02 (27.40), with a range of $0 to $300. Of 237 pharmacists asked who had naloxone in stock or who stated they could get naloxone in stock, 212 stated that they could demonstrate how to use it, 8 stated they could not, and 17 said that they possibly could or were unsure how to use it. CONCLUSIONS This study provided insight into the limited availability of naloxone at independent community pharmacies in Georgia after the standing order was issued. The majority of pharmacists at independent pharmacies in Georgia were not using the publicly available state naloxone standing order. Additionally, the low availability of naloxone and its high cost for uninsured individuals are significant structural barriers for reducing opioid-related mortality.
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Affiliation(s)
- Lauren Gilbert
- University of Houston College of Medicine, Houston, TX, USA
| | - Jennifer Elliott
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA, USA
| | - Lauren Beasley
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA, USA
| | - Ekene Oranu
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA, USA
| | - Kimberly Roth
- Mercer University School of Medicine, Savannah, GA, USA
| | - Jennifer Nguyễn
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA, USA.
- Mercer University School of Medicine, Savannah, GA, USA.
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Puzantian T, Gasper JJ, Ramirez CM. Pharmacist furnishing of naloxone in California: A follow-up analysis. J Am Pharm Assoc (2003) 2021; 61:e108-e112. [PMID: 34246575 DOI: 10.1016/j.japh.2021.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Increasing naloxone access in communities has been a priority to mitigate the increasing rate of opioid-related overdose deaths. OBJECTIVES The aims of this telephone survey were to estimate the availability of naloxone furnishing (provided without a prescription) by community pharmacists in California and examine the changes that occurred between 2018 and 2020. METHODS A telephone audit of a random representative sample of 1271 California licensed community pharmacies was conducted from January 22, 2020, to February 24, 2020. The results were compared with those of a survey of 1147 California licensed community pharmacies that was conducted from January 23, 2018, to February 28, 2018. The primary outcomes measured were naloxone availability without a prescription, information on formulations, cost, insurance billing, and stocking status. RESULTS There was a statistically significant increase in the furnishing of naloxone, as well as stocking and billing, in California from 2018 to 2020. Although fewer than half of the pharmacies were willing to provide naloxone without a prescription in 2020 (n = 487, 42.4%), this was an 80% increase from 2018 (P < 0.001). Of the pharmacies furnishing naloxone, many (n = 399, 81.9%) had nasal naloxone in stock, a large and statistically significant increase from 2018 when only 50.6% reported having it in stock (P < 0.001). In 2020, 90% of the pharmacies reported correctly that pharmacist-furnished naloxone could be billed to insurance compared with 56.9% in 2018 (P < 0.001). The median cash price of nasal naloxone (pack of 2) at chain pharmacies in 2020 was $131 (interquartile range [IQR] $129-$138) compared with $153 (IQR, $141-$163; P = 0.001) at independent pharmacies. CONCLUSION Community pharmacy-based access to naloxone increased in a statistically significant manner in California, although more than half of the pharmacies still do not provide such access. This study demonstrates the need for further efforts to expand community pharmacy-based access to naloxone.
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Hill LG, Loera LJ, Evoy KE, Renfro ML, Torrez SB, Zagorski CM, Perez JC, Jones SM, Reveles KR. Availability of buprenorphine/naloxone films and naloxone nasal spray in community pharmacies in Texas, USA. Addiction 2021; 116:1505-1511. [PMID: 33140519 DOI: 10.1111/add.15314] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Patients with opioid use disorder (OUD) must be able to obtain prescribed buprenorphine/naloxone films (BUP/NX) and naloxone nasal spray (NNS) from a pharmacy promptly to reduce risk for a recurrence of use and subsequent morbidity and mortality. Telephone audits have identified concerning gaps in availability of NNS within US pharmacies, but the availability of BUP/NX has not been rigorously evaluated. This study estimated the availability of BUP/NX and NNS in the US state of Texas and compared availability by pharmacy type and metropolitan status. DESIGN A cross-sectional telephone audit with a secret shopper approach conducted from 18 May 2020 to 7 June 2020. Setting and Participants A random sample of 800 of 5078 (16%) community pharmacies licensed with the Texas State Board of Pharmacy. MEASUREMENTS Primary outcomes included availability of a 1-week supply of generic BUP/NX 8/2 mg films and a single unit of NNS 4 mg, overall and by pharmacy type. Secondary outcomes included willingness and estimated time-frame to order BUP/NX if unavailable. FINDINGS Data from 704 pharmacies (471 chain, 233 independent) were included for analyses. Of these, 34.1% of pharmacies (45.0% of chains versus 12.0% of independents, P < 0.0001) were willing and able to dispense a 1-week supply of generic BUP/NX and a single unit of NNS. BUP/NX alone was available in 42.2% of pharmacies (52.4% of chains versus 21.5% of independents, P < 0.0001). NNS alone was available in 60.1% of pharmacies (77.9% of chains versus 24.0% of independents, P < 0.0001). Of the 397 pharmacies with generic BUP/NX unavailable, 62.2% of pharmacies (73.9% of chains versus 48.0% of independents, P < 0.0001) indicated willingness to order. CONCLUSIONS Most pharmacies in Texas do not appear to be willing and able to dispense prescribed buprenorphine/naloxone films and naloxone nasal spray to patients with opioid use disorder in a timely manner. Deficiencies in availability are markedly more pronounced in independent pharmacies compared with chain pharmacies.
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Affiliation(s)
- Lucas G Hill
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Lindsey J Loera
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kirk E Evoy
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Mandy L Renfro
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Sorina B Torrez
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Claire M Zagorski
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Joshua C Perez
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Shaun M Jones
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, Austin, TX, USA
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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Barnett BS, Wakeman SE, Davis CS, Favaro J, Rich JD. Expanding Mail-Based Distribution of Drug-Related Harm Reduction Supplies Amid COVID-19 and Beyond. Am J Public Health 2021; 111:1013-1017. [PMID: 33950718 PMCID: PMC8101586 DOI: 10.2105/ajph.2021.306228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Brian S Barnett
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
| | - Sarah E Wakeman
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
| | - Corey S Davis
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
| | - Jamie Favaro
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
| | - Josiah D Rich
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
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Petrosyan J, Tchalikian T, O'Connor A, Avakeretyan J, Dykhne M. Assessment of the Implementation of Pharmacists’ Prescriptive Authority to Furnish Hormonal Contraceptives, Naloxone, and Nicotine Replacement Therapy in California. J Contemp Pharm Pract 2021. [DOI: 10.37901/jcphp20-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background
California State Board of Pharmacy passed Senate Bill 493 authorizing pharmacists to furnish self-administered hormonal contraceptives, nicotine replacement products, and naloxone. Although California Senate Bill 493 expanded pharmacists’ scope of practice, limited implementation persists.
Objective
The objectives of this study were to assess the implementation of pharmacists’ prescriptive authority to furnish hormonal contraceptives, naloxone, and NRT in California as allowed by the Board of Pharmacy and availability of these services to patients in order to facilitate the development of strategies to expand them. The objective of the first part was to investigate reported awareness and barriers to implementation of services, while the second part was to report actual implementation rates.
Methods
This was an IRB-approved two-part cross-sectional survey that explored factors that may be associated with the limited implementation of the expanded scope of practice services.
Results
The two-part study had a total of 389 respondents. In the first part of the study, there were a total of 84 respondents. The majority reported that they were aware that pharmacists have the authority to furnish hormonal contraceptives, naloxone, and NRT, but services were limited. In the second part of the study, there were a total of 305 respondents, each responding to questions addressing only one of the three services: hormonal contraceptives (104 respondents), naloxone (101 respondents), and NRT (100 respondents). Within those subgroups, 19% of the respondents stated they offer hormonal contraceptives, 10% offer NRT, and 84% offer naloxone.
Conclusion
The results of the two-part study suggested that pharmacists’ authority to furnish these services were limited, thus patients’ access to these services were also limited.
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Peckham AM, Ball J, Colvard MD, Dadiomov D, Hill LG, Nichols SD, Tallian K, Ventricelli DJ, Tran TH. Leveraging pharmacists to maintain and extend buprenorphine supply for opioid use disorder amid COVID-19 pandemic. Am J Health Syst Pharm 2021; 78:613-618. [PMID: 33411894 PMCID: PMC7929456 DOI: 10.1093/ajhp/zxab003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose Strategies for deploying clinical pharmacists to increase access to buprenorphine in inpatient, outpatient and transitional care, and community practice settings are described. Summary Access to medications for opioid use disorder (MOUD) is essential, but patients face many barriers when pursuing treatment and MOUD. The coronavirus disease 2019 (COVID-19) pandemic has compounded the opioid crisis and worsened outcomes by introducing new barriers to MOUD access. Many strategies to ensure continued access to MOUD have been described, but the role of leveraging pharmacists during the opioid/COVID-19 syndemic to improve medication access and outcomes remains underappreciated. Pharmacists, while both qualified and capable of liberalizing access to all forms of MOUD, may have the strongest impact by increasing access to buprenorphine. Herein, we present progressive strategies to maintain and extend buprenorphine access for patients with OUD through deployment of clinical pharmacists, particularly in the context of the COVID-19 pandemic, during which access may be further restricted. Conclusion Leveraging pharmacists to extend access to MOUD, particularly buprenorphine, remains an underutilized strategy that should be implemented, particularly during the concurrent COVID-19 global pandemic.
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Affiliation(s)
- Alyssa M Peckham
- Northeastern University School of Pharmacy, Boston, MA.,Massachusetts General Hospital Substance Use Disorders Initiative, Boston, MA, USA
| | - Jennifer Ball
- South Dakota State University College of Pharmacy and Allied Health Professions, Brookings, SD.,University of South Dakota School of Medicine, Vermillion, SD, USA
| | - Michelle D Colvard
- Substance Use Disorder Transitions of Care Clinic, Inpatient Psychiatry and Addiction Services, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - David Dadiomov
- University of Southern California School of Pharmacy, Los Angeles, CA, and Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Lucas G Hill
- University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Stephanie D Nichols
- University of New England College of Pharmacy, Portland, ME, and Maine Medical Center Consult-Liaison Service, Portland, ME, USA
| | | | - Daniel J Ventricelli
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
| | - Tran H Tran
- Chicago Midwestern University, Chicago College of Pharmacy, Downers Grove, IL.,Rush University Medical Center Substance Use Intervention Team, Chicago, IL, USA
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Evoy KE, Hill LG, Davis CS. Considering the Potential Benefits of Over-the-Counter Naloxone. Integr Pharm Res Pract 2021; 10:13-21. [PMID: 33623754 PMCID: PMC7894851 DOI: 10.2147/iprp.s244709] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/27/2021] [Indexed: 01/30/2023] Open
Abstract
Since 1999, annual opioid-related overdose (ORO) mortality has increased more than six-fold. In response to this crisis, the US Department of Health and Human Services outlined a 5-point strategy to reduce ORO mortality which included the widespread distribution of naloxone, an opioid antagonist that can rapidly reverse an opioid overdose. Increased distribution has been facilitated by the implementation of naloxone access laws in each US state aimed at increasing community access to naloxone. While these laws differ from state-to-state, most contain mechanisms to enable pharmacists to dispense naloxone without a patient-specific prescription. These laws have enhanced community naloxone distribution, both from pharmacies and overdose education and naloxone distribution programs, and produced positive effects on ORO mortality. However, a growing body of evidence has revealed that significant barriers to naloxone access from pharmacies remain, and annual ORO deaths have continued to climb. Given these concerns, there has been a push among some clinicians and policymakers for the US Food and Drug Administration to re-classify naloxone as an over-the-counter (OTC) medication as a means to further increase its accessibility. If an OTC transition occurs, educational outreach and funding for clinical innovations will continue to be crucial given the important role of health professionals in recommending naloxone to people at risk for experiencing or witnessing an ORO. Recognizing the severity of the ORO public health crisis, we believe transitioning formulations of naloxone approved for layperson use to OTC status would result in a net benefit through increased access. However, such a change should be combined with measures to ensure affordability.
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Affiliation(s)
- Kirk E Evoy
- University Health, Department of Pharmacy, The University of Texas at Austin College of Pharmacy, San Antonio, TX, USA
| | - Lucas G Hill
- Pharmacy Practice, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
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Santa HM, Amirova SG, Ventricelli DJ, Downs GE, Nowalk AA, Pringle JL, Aruru M. Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order. Am J Health Syst Pharm 2021; 78:327-335. [PMID: 33336254 DOI: 10.1093/ajhp/zxaa387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County's being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. METHODS To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site-specific naloxone dispensing protocols. RESULTS Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists' understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists' self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. CONCLUSION Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists' knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.
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Affiliation(s)
- Heather M Santa
- Program Evaluation and Research Unit (PERU), University of Pittsburgh School of Pharmacy, Pittsburgh, PA
| | - Samira G Amirova
- Program Evaluation and Research Unit (PERU), University of Pittsburgh School of Pharmacy, Pittsburgh, PA
| | | | - George E Downs
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA
| | - Alexandra A Nowalk
- Program Evaluation and Research Unit (PERU), University of Pittsburgh School of Pharmacy, Pittsburgh, PA
| | - Janice L Pringle
- Program Evaluation and Research Unit (PERU), University of Pittsburgh School of Pharmacy, Pittsburgh, PA
| | - Meghana Aruru
- Program Evaluation and Research Unit (PERU), University of Pittsburgh School of Pharmacy, Pittsburgh, PA
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Ivsins A, Boyd J, Mayer S, Collins A, Sutherland C, Kerr T, McNeil R. "It's Helped Me a Lot, Just Like to Stay Alive": a Qualitative Analysis of Outcomes of a Novel Hydromorphone Tablet Distribution Program in Vancouver, Canada. J Urban Health 2021; 98:59-69. [PMID: 33118145 PMCID: PMC7592642 DOI: 10.1007/s11524-020-00489-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/16/2022]
Abstract
North America is experiencing an overdose crisis driven by fentanyl, related analogues, and fentanyl-adulterated drugs. In response, there have been increased calls for "safe supply" interventions based on the premise that providing a safer alternative (i.e., pharmaceutical drugs of known quality/quantity, non-adulterated, with user agency in consumption methods) to the street drug supply will limit people's use of fentanyl-adulterated drugs and reduce overdose events. This study examined outcomes of a hydromorphone tablet distribution program intended to prevent overdose events among people who use drugs (PWUD) at high risk of fatal overdose. Semi-structured qualitative interviews were conducted with 42 people enrolled in the hydromorphone distribution program. Additionally, over 100 h of ethnographic observation were undertaken in and around the study site. Transcripts were coded using NVivo and based on categories extracted from the interview guides and those identified during initial interviews and ethnographic fieldwork. Analysis focused on narratives around experiences with the program, focusing on program-related outcomes. Our analysis identified the following positive outcomes of being enrolled in the hydromorphone tablet distribution program: (1) reduced street drug use and overdose risk, (2) improvements to health and well-being, (3) improvements in co-management of pain, and (4) economic improvements. Our findings indicate that the hydromorphone distribution program not only is effective in responding to the current overdose crisis by reducing people's use of illicit drugs but also addresses inequities stemming from the intersection of drug use and social inequality. Safe supply programs should be further implemented and evaluated in both urban and rural setting across North America as a strategy to reduce exposure to the toxic drug supply and fatal overdose.
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Affiliation(s)
- Andrew Ivsins
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia, V6Z 2A9, Canada
| | - Alexandra Collins
- Brown University School of Public Health, 121 S Main St, Providence, RI, 02903, USA
| | - Christy Sutherland
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia, V6Z 2A9, Canada
- PHS Community Services, 9 E Hastings St, Vancouver, British Columbia, V6A 1M9, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
- Program in Addiction Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
- General Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
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Toce MS, Hadland SE. Commentary on Hill et al.: Breaking down barriers-increasing access to lifesaving opioid use disorder medications to save lives. Addiction 2021; 116:1512-1513. [PMID: 33403685 PMCID: PMC8131207 DOI: 10.1111/add.15375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
Numerous barriers exist for patients attempting to access treatment for opioid-use disorder and/or naloxone, with geographical, racial, and age-related differences exacerbating these hardships.
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Affiliation(s)
- Michael S. Toce
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA,Harvard Medical Toxicology Program, Boston, MA
| | - Scott E. Hadland
- Department of Pediatrics, Boston Medical Center, Boston, MA,Division of General Pediatrics, Boston University School of Medicine, Boston, MA
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Abbas B, Marotta PL, Goddard-Eckrich D, Huang D, Schnaidt J, El-Bassel N, Gilbert L. Socio-ecological and pharmacy-level factors associated with naloxone stocking at standing-order naloxone pharmacies in New York City. Drug Alcohol Depend 2021; 218:108388. [PMID: 33285392 PMCID: PMC11077322 DOI: 10.1016/j.drugalcdep.2020.108388] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Research on socio-ecological factors that may impede or facilitate access to naloxone in pharmacies remains limited. This study investigated associations between socio-ecological factors, pharmacy participation in the naloxone cost assistance program (NCAP), pharmacy characteristics and having naloxone in stock among pharmacies in New York City. METHODS Phone interviews were conducted with 662 pharmacies selected from the New York City Naloxone Standing Order List. Multi-level generalized linear modeling estimated associations between neighborhood racial and ethnic composition, poverty rates, overdose fatality rates, pharmacy participation in N-CAP, having private physical spaces within the pharmacy, knowledge of where to refer people to obtain naloxone and adjusted relative risk (aRR) that the pharmacy would have naloxone in stock. RESULTS Findings from this study supported several of the hypotheses. Greater neighborhood poverty was associated with a lower likelihood of carrying naloxone compared to neighborhoods with less poverty (aRR = .79, CI95 % = .69, .90, p < .001). Pharmacies that provided a private window for consultations (aRR = 1.34, CI95 % = 1.19, 1.51, p < .001), a private room (aRR = 1.42, CI95 % = 1.30, 1.56, p < .001), and a private area (aRR = 1.42, CI95 % = 1.30, 1.56, p < .001) were associated with a higher likelihood of carrying naloxone compared than those that did not. CONCLUSIONS Findings from this study suggest that community-level socioeconomic marginalization is a contributor to disparities in naloxone availability among pharmacies in New York City. Findings support harm reduction interventions tailored to the built environment of pharmacies that respect privacy to those seeking naloxone.
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Affiliation(s)
- Bilal Abbas
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
| | - Phillip L Marotta
- Washington University - St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO, 63130, United States.
| | - Dawn Goddard-Eckrich
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
| | - Diane Huang
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
| | - Jakob Schnaidt
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
| | - Nabila El-Bassel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
| | - Louisa Gilbert
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
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Hincapie AL, Hegener M, Heaton PC, Fish G, Fetters K, Sneed GT, Koechlin K, DeFiore-Hyrmer J, Holthusen A, MacKinnon NJ. Challenges and Facilitators of Implementing a Physician-approved Naloxone Protocol: A Mixed-methods Study. J Addict Med 2021; 15:40-48. [PMID: 33534508 DOI: 10.1097/adm.0000000000000672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In 2015, the State of Ohio passed legislation to allow pharmacists to dispense naloxone under a physician-approved protocol. The legislation allows all individuals authorized under a physician-approved protocol to personally furnish naloxone without requiring clients to be seen by a licensed prescriber, thus expanding the capacity of Ohio's community distribution programs. We aimed to evaluate the implementation of legislation allowing for a physician-approved protocol in pharmacies and other naloxone distribution sites in Ohio, and to compare barriers and facilitators of implementing the law changes among sites that implemented a physician-approved protocol versus sites that did not. METHODS The study used a convergent parallel mixed-method design. Random samples from all pharmacies registered with the State of Ohio Board of Pharmacy and community naloxone distribution sites were selected. Quantitative data were collected via survey (n = 168) and qualitative data were collected via semi-structured interviews (n = 17). RESULTS Most survey respondents agreed that the policy has expanded access to naloxone at their site for individuals who want or need the medication. Both pharmacies and other naloxone distribution sites identified that leadership and organizational support facilitated protocol implementation and cost, stigma, and lack of naloxone demand challenged protocol implementation. CONCLUSIONS The study identified barriers and facilitators to the implementation of a physician-approved protocol within Ohio. The majority of respondents stated they could implement a protocol. However, barriers of cost, lack of public awareness of naloxone availability, and stigma remain for pharmacies and other naloxone distribution sites.
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Affiliation(s)
- Ana L Hincapie
- University of Cincinnati James L. Winkle College of Pharmacy, 3255 Eden Ave, Cincinnati, OH 45267 (ALH, MHP, PCH, GF, KF, GTS, NJMK); Ohio Department of Health, 246 N. High St. Columbus, OH 43215 (KK, JDF-H)
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Abstract
When new drugs are approved by the Food and Drug Administration, the default assumption is that they will be available by prescription only, safe for use exclusively under clinical supervision. The paternalism underlying this default must be interrogated in order to ensure appropriate respect for patient autonomy. Upon closer inspection, prescription requirements are justified when nonprescription status would risk harm to third parties and when a large segment of the population would struggle to exercise their autonomy in using a drug safely and effectively on their own. Although these justifications can support prescription status for many drugs, we propose that reversing the FDA's current default to instead begin with a presumption in favor of over-the-counter status is the best way to avoid interference with valid claims of patient autonomy. Under this approach, a range of drug products could be considered for an OTC switch, including oral contraceptives, statins, and HIV-prevention drugs.
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Contreras J, Baus C, Brandt C, Witry M, Peters J, Evoy KE. Pharmacist counseling when dispensing naloxone by standing order: A secret shopper study of 4 chain pharmacies. J Am Pharm Assoc (2003) 2020; 61:e94-e99. [PMID: 33153912 DOI: 10.1016/j.japh.2020.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Texas has passed legislation to increase access to naloxone, the opioid overdose antidote, allowing pharmacists to dispense by standing order without an outside prescription. Given this added responsibility, there is a need to assess real-world counseling provided by pharmacists when dispensing naloxone. OBJECTIVES Assess naloxone accessibility and counseling provided by community pharmacists when dispensing naloxone by standing order. METHODS A total of 11 student pharmacists (mean age 25 years; 63.6% female; primarily Hispanic [36.4%], Asian [27.3%], and white [27.3%]) audited community pharmacies by presenting to purchase naloxone. Variables included naloxone availability and price, counseling duration, and whether 13 predetermined counseling points were provided unprompted. Shoppers were prepared with a background story if asked so that each answered questions consistently. All shoppers participated in two 1-hour training sessions, including verification of their ability to accurately assess naloxone counseling. Pharmacies in Bexar County, TX were selected randomly from 4 pharmacy chains, each of which have implemented statewide standing orders within their chain. Descriptive statistics were calculated. A Fisher exact test and linear mixed-effects regression model were used to assess variation across chains in whether naloxone was dispensed and the mean total number of counseling points provided, respectively. RESULTS The shoppers audited 45 pharmacies. Naloxone was dispensed in 31 of 45 (68.9%) encounters (mean cost: $129.59). The mean counseling duration was 89 seconds. The most common counseling points included: administration technique (24 of 31), readministration of second dose (22 of 31), and calling 9-1-1 (20 of 31). All other points were included in less than one-third of pharmacists' counseling. Across the 4 chains, there was significant variation in naloxone dispensing and the number of counseling points provided. CONCLUSION Secret shoppers were unable to access naloxone from nearly one-third of pharmacies. Counseling often excluded concepts pertinent to patient safety and effectiveness, suggesting opportunities remain to promote consistent, high-quality naloxone counseling in community pharmacies.
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Green TC, Bratberg J, Baird J, Burstein D, Lenz K, Case P, Walley AY, Xuan Z. Rurality and differences in pharmacy characteristics and community factors associated with provision of naloxone in the pharmacy. International Journal of Drug Policy 2020; 85:102602. [DOI: 10.1016/j.drugpo.2019.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/19/2019] [Accepted: 11/10/2019] [Indexed: 02/01/2023]
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Ivsins A, Boyd J, Mayer S, Collins A, Sutherland C, Kerr T, McNeil R. Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study. Drug Alcohol Depend 2020; 216:108202. [PMID: 32948372 PMCID: PMC7490624 DOI: 10.1016/j.drugalcdep.2020.108202] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND North America is experiencing an overdose crisis driven by illicitly-manufactured fentanyl, related analogues, and fentanyl-adulterated drugs. The concept of 'safe supply' has been suggested as a potential measure to address the overdose crisis by providing a regulated alternative to illicit opioids to people at high risk of fatal overdose. In January 2019, a novel hydromorphone tablet distribution program was implemented within an overdose prevention site in Vancouver, Canada's Downtown Eastside neighbourhood. This study explored barriers and facilitators to engagement with this program. METHODS In-depth interviews were conducted with 42 participants enrolled in the hydromorphone tablet distribution program, and over 100 h of ethnographic observation were conducted in and around the study site. Thematic analysis of the interviews and ethnographic observation focused on program operation, including barriers and facilitators to program uptake, access, and engagement. RESULTS Barriers to program engagement identified include: limited operating hours and dose schedule, co-location within the overdose prevention site (e.g., wait times), and receiving the generic formulation of hydromorphone. Facilitators identified include: having access to a reliable source of opioids, co-location within the overdose prevention site (e.g., low-barrier design), experiences of agency, and program flexibility. CONCLUSION Our findings demonstrate key implementation and operational considerations of safe supply programs. In particular, lower-barrier design and operational features should be considered to improve uptake and engagement. Safe opioid supply programs are a promising intervention to address North America's ongoing overdose crisis by providing people at high risk of fatal overdose an alternative to the toxic drug supply.
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Affiliation(s)
- Andrew Ivsins
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400 Vancouver, British Columbia, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall Vancouver, British Columbia, V6T 1Z3, Canada.
| | - Jade Boyd
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400 Vancouver, British Columbia, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall Vancouver, British Columbia, V6T 1Z3, Canada.
| | - Samara Mayer
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400 Vancouver, British Columbia, V6Z 2A9, Canada.
| | - Alexandra Collins
- Brown University School of Public Health, 121 S Main St Providence, Rhode Island 02903, USA.
| | - Christy Sutherland
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400 Vancouver, British Columbia, V6Z 2A9, Canada; PHS Community Services, 9 E Hastings St Vancouver, British Columbia, V6A 1M9, Canada.
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400 Vancouver, British Columbia, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall Vancouver, British Columbia, V6T 1Z3, Canada.
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400 Vancouver, British Columbia, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall Vancouver, British Columbia, V6T 1Z3, Canada; Program in Addiction Medicine, Yale School of Medicine 333 Cedar St, New Haven, CT 06510, United States; General Internal Medicine, Yale School of Medicine 333 Cedar St, New Haven, CT 06510, United States.
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Coon SA, Hill LG, Hutchison RW, Arnold LM, Jarrett JB, Ottney AR, Oung AB, Painter NA, Smith MA, Stranges PM, Tran TH, McFee Winans AR, Bratberg JP. Mobilizing pharmacists to address the opioid crisis: A joint opinion of the ambulatory care and adult medicine practice and research networks of the American College of Clinical Pharmacy. J Am Coll Clin Pharm 2020. [DOI: 10.1002/jac5.1331] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Scott A. Coon
- Department of Pharmacotherapeutics & Clinical Research University of South Florida, Taneja College of Pharmacy, Morsani College of Medicine Tampa Florida USA
| | - Lucas G. Hill
- Division of Pharmacy Practice The University of Texas at Austin College of Pharmacy Austin Texas USA
| | - Robert W. Hutchison
- Department of Pharmacy Practice Texas A&M Irma Lerma Rangel College of Pharmacy Round Rock Texas USA
| | - Lindsay M. Arnold
- Department of Pharmacy Services St. Elizabeth's Medical Center Brighton Massachusetts USA
| | - Jennie B. Jarrett
- Department of Pharmacy Practice University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
| | - Anne R. Ottney
- Department of Pharmacy Practice Ferris State University, College of Pharmacy Big Rapids Michigan USA
| | - Alvin B. Oung
- Department of Pharmacy Practice University of Wyoming School of Pharmacy Laramie Wyoming USA
| | - Nathan A. Painter
- Division of Clinical Pharmacy University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences San Diego California USA
| | - Michael A. Smith
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | - Paul M. Stranges
- Department of Pharmacy Practice University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
| | - Tran H. Tran
- Department of Pharmacy Practice Midwestern University Chicago College of Pharmacy Downers Grove Illinois USA
| | - Amanda R. McFee Winans
- Section of Clinical Pharmacy, Department of Pharmaceutical Care Services Bassett Medical Center Cooperstown New York USA
| | - Jeffrey P. Bratberg
- Department of Pharmacy Practice University of Rhode Island College of Pharmacy Kingston Rhode Island USA
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Renfro ML, Moczygemba LR, Baumgartner J, Baumgart G, Hill LG. Opioid-Related Education Provided by Continuing Education Divisions at US Pharmacy Schools. Am J Pharm Educ 2020; 84:ajpe8001. [PMID: 33149331 PMCID: PMC7596601 DOI: 10.5688/ajpe8001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/17/2020] [Indexed: 05/28/2023]
Abstract
Objective. To quantify the number and type of new opioid-related continuing pharmacy education (CPE) activities offered by continuing education divisions (CEDs) at US schools and colleges of pharmacy from 2015 through 2018, and to determine the number of pharmacists who completed opioid-related CPE activities. Methods. Data was derived from the database of CPE activities maintained by the Accreditation Council for Pharmacy Education (ACPE), which is the sole accreditation agency for all providers of CPE, including pharmacy schools. Data were filtered to include only pharmacy school CPE providers. A search for six keywords (opiates, opioids, pain, pain management, drug overdose, and opioid antagonist) was conducted for the years 2015-2018. The data extracted included title of the CPE activity, contact hours, activity type, activity format, and the number of pharmacists who participated in the activity. Descriptive statistics were used. A content analysis of activity titles was performed. Results. Overall, the CEDs of US schools and colleges of pharmacy delivered 20.3% of all ACPE-approved opioid-related CPE activities from 2015-2018. A total of 1,237 unique opioid-related CPE activities were identified. The number of new CPE activities increased from 249 in 2015 to 297 in 2016 to 349 in 2017, then decreased to 342 in 2018. These activities reached 149,373 pharmacists and were most commonly affiliated with the following keywords: opioids (34.8%) and pain management (30.2%). Conclusion. The opioid epidemic creates an opportunity for pharmacists to increase their role in public health, but education and training are necessary. The study findings indicate that many pharmacists participate in opioid-related CPE provided by ACPE-accredited CEDs of pharmacy schools. This number is likely to increase as a growing number of states are beginning to require opioid-related CPE for pharmacist license renewal.
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Affiliation(s)
- Mandy L. Renfro
- The University of Texas at Austin College of Pharmacy, Austin, Texas
| | | | | | - Glen Baumgart
- The University of Texas at Austin College of Pharmacy, Austin, Texas
| | - Lucas G. Hill
- The University of Texas at Austin College of Pharmacy, Austin, Texas
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Nguyen AM, Kearney TE, Apollonio DE. Evaluation of naloxone furnishing community pharmacies in San Francisco. J Am Pharm Assoc (2003) 2020; 60:1050-1057.e1. [PMID: 32948461 DOI: 10.1016/j.japh.2020.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/24/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In 2017, the Centers for Disease Control and Prevention reported more than 47,600 deaths as a result of opioid overdose in the United States. In an effort to reduce these deaths, California passed legislation providing pharmacists with the ability to furnish naloxone without a prescription. Our study examined pharmacies in San Francisco that furnished naloxone and provided guidance for pharmacies seeking to develop similar programs. The study aims were to (1) identify the legal, structural, social-environmental, and financial components of a pharmacy model that allows for successful naloxone distribution, (2) evaluate the attitudes and beliefs of pharmacy staff members toward patients receiving or requesting naloxone, and (3) assess relationships between these attitudes and beliefs and naloxone furnishing at the pharmacy. METHODS This cross-sectional study used a series of semistructured interviews of pharmacy staff in San Francisco conducted April-October 2019. Through a thematic, inductive analysis of collected data, emerging themes were mapped to the primary study aims. RESULTS We interviewed 14 pharmacists and pharmacy technicians at 4 community pharmacies. We identified 4 factors for success in implementing a naloxone furnishing protocol: administrative-led efforts, pharmacist-led efforts, increasing pharmacist engagement, and increasing patient engagement. The respondents also discussed the approaches they used to overcome previously identified barriers: cost, time, expectations of unwanted clientele, and patients' feelings of stigma. CONCLUSION Pharmacists' approaches to implementing naloxone furnishing had common features across locations, suggesting many of these strategies could be replicated in other community pharmacies.
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Salgado TM, Rosenthal MM, Coe AB, Kaefer TN, Dixon DL, Farris KB. Primary healthcare policy and vision for community pharmacy and pharmacists in the United States. Pharm Pract (Granada) 2020; 18:2160. [PMID: 33029264 PMCID: PMC7523559 DOI: 10.18549/pharmpract.2020.3.2160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.
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Affiliation(s)
- Teresa M Salgado
- MPharm, PhD. Center for Pharmacy Practice Innovation, School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Meagen M Rosenthal
- PhD. Department of Pharmacy Administration, School of Pharmacy, University of Mississippi. Oxford, MS (United States).
| | - Antoinette B Coe
- PharmD, PhD. Department of Clinical Pharmacy, College of Pharmacy, University of Michigan. Ann Arbor, MI (United States).
| | - Tana N Kaefer
- PharmD. Director of Clinical Services, Bremo Pharmacy. Richmond, VA (United States).
| | - Dave L Dixon
- PharmD. Center for Pharmacy Practice Innovation, School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Karen B Farris
- PhD. Department of Clinical Pharmacy, College of Pharmacy, University of Michigan. Ann Arbor, MI (United States).
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Strand MA, Eukel H, Frenzel O, Skoy E, Steig J, Werremeyer A. Program evaluation of the Opioid and Naloxone Education (ONE Rx) program using the RE-AIM model. Res Social Adm Pharm 2020; 16:1248-1254. [DOI: 10.1016/j.sapharm.2019.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/18/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022]
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Reyes LD, Hong J, Lin C, Hamper J, Kroon L. Community Pharmacists' Motivation and Barriers to Providing and Billing Patient Care Services. Pharmacy (Basel) 2020; 8:pharmacy8030145. [PMID: 32824042 PMCID: PMC7559800 DOI: 10.3390/pharmacy8030145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 11/25/2022] Open
Abstract
Recently, California (CA) pharmacists’ scope of practice has expanded to include independently prescribing self-administered hormonal contraceptives, nicotine replacement therapy medications, travel health medications, routine vaccinations, naloxone hydrochloride, and HIV preexposure and postexposure prophylaxis. However, previous reports indicate that practicing within this expanded scope has remained limited. Therefore, a 26-item, web-based survey was emailed to CA community pharmacists to assess pharmacists’ knowledge, intent, and barriers to prescribing and billing for these patient care services. A total of 216 chain, supermarket-based, independent, mass merchant, and health-system outpatient pharmacists were included. The primary services provided and medications prescribed are for vaccinations and naloxone. Most pharmacists agree that engagement in and implementation of new strategies to enhance patients’ access to care is important. Common barriers include patient unawareness of pharmacist-provided services, lack of payment for services, and difficulty incorporating services within pharmacy workflow. Pharmacists are confident in their ability to provide patient care services but are less knowledgeable and confident about billing for them. Enhancing promotion of pharmacist-provided services to patients, developing strategies to efficiently incorporate them into the workflow, and payment models can help overcome barriers to providing these services.
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Affiliation(s)
- Liesl D. Reyes
- Albertsons Companies, Pleasanton, CA 94588, USA; (L.D.R.); (J.H.); (C.L.); (J.H.)
- School of Pharmacy, University of California, San Francisco, CA 94143, USA
| | - Jenny Hong
- Albertsons Companies, Pleasanton, CA 94588, USA; (L.D.R.); (J.H.); (C.L.); (J.H.)
| | - Christine Lin
- Albertsons Companies, Pleasanton, CA 94588, USA; (L.D.R.); (J.H.); (C.L.); (J.H.)
| | - Jeffrey Hamper
- Albertsons Companies, Pleasanton, CA 94588, USA; (L.D.R.); (J.H.); (C.L.); (J.H.)
| | - Lisa Kroon
- School of Pharmacy, University of California, San Francisco, CA 94143, USA
- Correspondence:
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Wu C, Brown T, Moreno JL. Access to naloxone at community pharmacies under the Massachusetts statewide standing order. J Am Pharm Assoc (2003) 2020; 60:647-652. [DOI: 10.1016/j.japh.2019.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/11/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022]
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Abstract
North America is experiencing an unprecedented overdose crisis driven by the proliferation of fentanyl and its analogues in the illicit drug supply. In 2018 there were 67,367 drug overdose deaths in the United States, and since 2016, there have been more than 14,700 overdose deaths in Canada, with most related to fentanyl. Despite concerted efforts and some positive progress, current public health, substance use treatment, and harm reduction interventions (such as widespread naloxone distribution and implementation of supervised consumption sites) have not been able to rapidly decrease overdose fatalities. In view of the persistent gaps in services and the limitations of available options, immediate scale-up of low-barrier opioid distribution programs are urgently needed. This includes "off-label" prescription of pharmaceutical grade opioids (e.g., hydromorphone) to disrupt the toxic drug supply and make safer opioids widely available to people at high risk of fatal overdose.
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Affiliation(s)
- Andrew Ivsins
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC, V6Z 2A9, Canada.
| | - Jade Boyd
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC, V6Z 2A9, Canada
| | - Leo Beletsky
- Health in Justice Action Lab, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States; UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Ryan McNeil
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC, V6Z 2A9, Canada; General Internal Medicine, Yale School of Medicine, 367 Cedar St, New Haven, CA 06510, United States; Program in Addiction Medicine, Yale School of Medicine, 367 Cedar St, New Haven, CA 06510, United States
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Egan KL, Foster SE, Knudsen AN, Lee JGL. Naloxone Availability in Retail Pharmacies and Neighborhood Inequities in Access. Am J Prev Med 2020; 58:699-702. [PMID: 32005590 DOI: 10.1016/j.amepre.2019.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study examines the implementation of North Carolina's statewide naloxone standing order and identifies community characteristics associated with pharmacy stocking and willingness to sell naloxone under the standing order. METHODS In April-June 2019, a mystery caller protocol was completed to assess if (1) North Carolina pharmacies had naloxone available and were willing to dispense it without a prescription, (2) pharmacy characteristics associated with availability, and (3) there were neighborhood differences (e.g., Census tract population size, density, racial composition, SES, rates of opioid overdoses, and rates of opioid prescriptions dispensed) in availability. Using random sampling stratified by inclusion on North Carolina's public list of pharmacies participating in the standing order, chain, independent, and health department pharmacies in North Carolina were sampled (n=161 of 2,044). In June 2019, the data were analyzed. Survey weights were utilized to calculate the prevalence of availability, and regression models were conducted to examine associations. RESULTS An estimated 61.7% (95% CI=54.3, 68.5) of North Carolina retail pharmacies have naloxone available without a prescription. The odds of naloxone availability were lower for independent pharmacies than chains (OR=0.12, 95% CI=0.06, 0.25). Inclusion on North Carolina's public list of pharmacies had greater odds of naloxone availability (OR=2.32, 95% CI=1.22, 4.43). Naloxone availability was lower in communities with higher percentages of residents with public health insurance (OR=0.97, 95% CI=0.95, 0.999). CONCLUSIONS Though more than half of the pharmacies in North Carolina participate in the standing order for naloxone, efforts to identify the best practices for ensuring widespread implementation of statewide standing orders for naloxone are warranted.
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Affiliation(s)
- Kathleen L Egan
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina.
| | - Samantha E Foster
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina
| | - Ashton N Knudsen
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina
| | - Joseph G L Lee
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina; Center for Health Disparities, East Carolina University, Greenville, North Carolina
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Haffajee RL, Cherney S, Smart R. Legal requirements and recommendations to prescribe naloxone. Drug Alcohol Depend 2020; 209:107896. [PMID: 32058248 PMCID: PMC7127952 DOI: 10.1016/j.drugalcdep.2020.107896] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The continued toll of opioid-related overdoses has motivated efforts to expand availability of naloxone to persons at high risk of overdose, with 2016 federal guidance encouraging clinicians to co-prescribe naloxone to patients with increased overdose risk. Some states have pursued analogous or stricter legal requirements that could more heavily influence prescriber behavior. METHODS We conducted a systematic legal review of state laws that mandate or recommend that healthcare providers prescribe naloxone to patients with indicators for opioid overdose risk. We coded relevant statutes and regulations for: applicable populations, patient criteria, educational requirements, and exemptions. RESULTS As of September 2019, 17 states had enacted naloxone co-prescribing laws, the earliest of which was implemented by Louisiana in January 2016. If patient overdose risk criteria are met, over half of these states mandate that providers prescribe naloxone (7 states, 41.1 %) or offer a naloxone prescription (2 states, 11.8 %); the remainder encourage prescribers to consider prescribing naloxone (8 states). Most states (58.8 %) define patient overdose risk based on opioid dosages prescribed, although the threshold varies substantially; other common overdose risk criteria include concomitant opioid and benzodiazepine prescriptions and patient history of substance use disorder or mental illness. CONCLUSIONS A growing minority of states has adopted a naloxone prescribing law, although these policies remain less prevalent than other naloxone access laws. By targeting higher-risk patients during clinical encounters, naloxone prescribing requirements could increase naloxone prescribed, destigmatize naloxone use, and reduce overdose harms. Further investigation into policy effectiveness, unintended consequences, and appropriate parameters is warranted.
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Affiliation(s)
- Rebecca L. Haffajee
- RAND Corporation, Boston, MA, United States,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States,Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, United States,Corresponding author at: RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, United States. (R.L. Haffajee)
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Abstract
BACKGROUND Opioid overdose is a preventable injury leading to high morbidity and premature mortality in communities across the United States. Overdoses take place where people use drugs, including commercial and public locations like community pharmacies, and necessitate swift detection and response to avoid harm and, even more seriously, death. The presence of emergency and safety protocols improves occupational health and safety for all in the workplace. The aim of this study was to assess the prevalence of experience with on-site pharmacy overdose and to explore pharmacist and site characteristics associated with having a known protocol for responding to on-site overdose emergencies. Methods: An anonymous, online survey about naloxone provision and opioid safety was delivered by email, through professional pharmacy associations and continuing education attendance lists, to 3,100 pharmacists in Massachusetts and Rhode Island between October 2017 and January 2018. Survey items gauged socio-demographics, practice site characteristics, safer opioid dispensing and naloxone provision. Summary statistics and bivariate analyses were conducted to describe characteristics associated with items pertaining to on-site overdose policy awareness. Results: Of the 357 respondents (11.5% response rate), 154 (5.0%) answered the questions of interest: 17.5% reported having at least one suspected overdose on-site at their practice location, while 42.9% reported that they were knowledgeable about and could locate at their practice location an on-site overdose protocol detailing how to respond to an overdose. Pharmacists who were knowledgeable about protocols were also more likely to offer naloxone to patients (p = 0.02) and did not practice at a chain pharmacy (p = 0.01). Conclusions: Community pharmacies that stock and distribute naloxone are key parts of community efforts to address the opioid crisis. Pharmacies and other healthcare settings should develop and implement on-site overdose response protocols and cultivate a norm of naloxone provision to patients.
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Affiliation(s)
- Traci C Green
- Department of Emergency Medicine, Injury Prevention Center, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Emergency Medicine, Injury Prevention Center, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ayorinde Soipe
- Department of Emergency Medicine, Injury Prevention Center, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Brianna Baloy
- Department of Emergency Medicine, Injury Prevention Center, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dina Burstein
- Department of Emergency Medicine, Injury Prevention Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Abigail Tapper
- Department of Emergency Medicine, Injury Prevention Center, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Patricia Case
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Jeffrey Bratberg
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Janette Baird
- Department of Emergency Medicine, Injury Prevention Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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MAURI AMANDAI, TOWNSEND TARLISEN, HAFFAJEE REBECCAL. The Association of State Opioid Misuse Prevention Policies With Patient- and Provider-Related Outcomes: A Scoping Review. Milbank Q 2020; 98:57-105. [PMID: 31800142 PMCID: PMC7077777 DOI: 10.1111/1468-0009.12436] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Policy Points This scoping review reveals a growing literature on the effects of certain state opioid misuse prevention policies, but persistent gaps in evidence on other prevalent state policies remain. Policymakers interested in reducing the volume and dosage of opioids prescribed and dispensed can consider adopting robust prescription drug monitoring programs with mandatory access provisions and drug supply management policies, such as prior authorization policies for high-risk prescription opioids. Further research should concentrate on potential unintended consequences of opioid misuse prevention policies, differential policy effects across populations, interventions that have not received sufficient evaluation (eg, Good Samaritan laws, naloxone access laws), and patient-related outcomes. CONTEXT In the midst of an opioid crisis in the United States, an influx of state opioid misuse prevention policies has provided new opportunities to generate evidence of policy effectiveness that can inform policy decisions. We conducted a scoping review to synthesize the available evidence on the effectiveness of US state interventions to improve patient and provider outcomes related to opioid misuse and addiction. METHODS We searched six online databases to identify evaluations of state opioid policies. Eligible studies examined legislative and administrative policy interventions that evaluated (a) prescribing and dispensing, (b) patient behavior, or (c) patient health. FINDINGS Seventy-one articles met our inclusion criteria, including 41 studies published between 2016 and 2018. These articles evaluated nine types of state policies targeting opioid misuse. While prescription drug monitoring programs (PDMPs) have received considerable attention in the literature, far fewer studies addressed other types of state policy. Overall, evidence quality is very low for the majority of policies due to a small number of evaluations. Of interventions that have been the subject of considerable research, promising means of reducing the volume and dosages of opioids prescribed and dispensed include drug supply management policies and robust PDMPs. Due to low study number and quality, evidence is insufficient to draw conclusions regarding interventions targeting patient behavior and health outcomes, including naloxone access laws and Good Samaritan laws. CONCLUSIONS Recent research has improved the evidence base on several state interventions targeting opioid misuse. Specifically, moderate evidence suggests that drug supply management policies and robust PDMPs reduce opioid prescribing. Despite the increase in rigorous evaluations, evidence remains limited for the majority of policies, particularly those targeting patient health-related outcomes.
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Affiliation(s)
- AMANDA I. MAURI
- University of Michigan School of Public Health
- Injury Prevention CenterUniversity of Michigan Medical School
| | - TARLISE N. TOWNSEND
- University of Michigan School of Public Health
- Injury Prevention CenterUniversity of Michigan Medical School
- University of Michigan Department of Sociology
| | - REBECCA L. HAFFAJEE
- University of Michigan School of Public Health
- Injury Prevention CenterUniversity of Michigan Medical School
- RAND Corporation
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Abstract
BACKGROUND Prescribing naloxone to patients is a key strategy to prevent opioid overdoses, but little is known about the reach of naloxone prescribing. OBJECTIVE Determine patient factors associated with receiving naloxone and trends over time in patients with key overdose risk factors. DESIGN Retrospective observational study. PARTICIPANTS Using the Clinformatics DataMart, a US-wide health insurance claims dataset, we compared adults who received opioids and naloxone (opioid+naloxone) from January 2014 to June 2017 with adults who received opioids without naloxone (opioids only), matched on gender, age ± 5 years, month/year of opioid fill, and number of opioid claims. MAIN MEASURES Key patient-level opioid overdose risk factors included receipt of high-dosage opioids, concurrent benzodiazepines, history of opioid and other substance use disorders, and history of opioid overdose. RESULTS We included 3963 opioid+naloxone and 19,815 opioid only patients. Key factors associated with naloxone fills included high opioid daily dosage (50 to < 90 morphine milligram equivalents (MME): AOR = 2.43, 95% CI 2.15-2.76 and ≥ 90 MME: AOR = 3.94, 95% CI 3.47-4.46; reference: < 50 MME), receiving concurrent benzodiazepines (AOR = 1.27, 95% CI 1.16-1.38), and having a diagnosis of opioid use disorder (AOR = 1.56, 95% CI 1.40-1.73). History of opioid overdose was not associated with naloxone (AOR = 0.92, 95% CI 0.74-1.15). The percent of patients receiving naloxone increased, yet less than 2% of patients in any of the key overdose risk factor groups received naloxone by the last 6 months of the study period. CONCLUSIONS Naloxone prescribing has increased and was more likely to be co-prescribed to patients with some risk factors for overdose. However, overall prescribing remains minimal. Additional efforts are needed across health systems to increase naloxone prescribing for patients at risk for opioid overdose.
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Affiliation(s)
- Lewei Allison Lin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. .,VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA.
| | - Chad M Brummett
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer F Waljee
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael J Englesbe
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Vidhya Gunaseelan
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA
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Evoy KE, Groff L, Hill LG, Godinez W, Gandhi R, Reveles KR. Impact of student pharmacist–led naloxone academic detailing at community pharmacies in Texas. J Am Pharm Assoc (2003) 2020; 60:81-86. [DOI: 10.1016/j.japh.2019.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/15/2022]
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Pett RG, Mancl L, Revere D, Stergachis A. Prescription drug monitoring program use and utility by Washington State pharmacists: A mixed-methods study. J Am Pharm Assoc (2003) 2020; 60:57-65. [DOI: 10.1016/j.japh.2019.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/14/2019] [Accepted: 09/24/2019] [Indexed: 12/19/2022]
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Thakur T, Frey M, Chewning B. Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review. J Am Pharm Assoc (2003) 2020; 60:178-194. [DOI: 10.1016/j.japh.2019.06.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023]
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Hurt BR, Hussain A, Aledhaim A, Moayedi S, Schenkel SM, Kim HK. Access and Barriers to Take-Home Naloxone Use among Emergency Department Patients with Opioid Misuse in Baltimore, Maryland, USA. Subst Use Misuse 2020; 55:2237-2242. [PMID: 32729772 DOI: 10.1080/10826084.2020.1797811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The opioid epidemic has prompted the expansion of take-home naloxone (THN) distribution programs. The proportion of emergency department (ED) patients with opioid misuse who have access to a naloxone kit (NK) and barriers to using it are unclear. Objective: Characterizing the access and barrier to NK use among at-risk ED patients. Methods: We enrolled a convenience sample of ED patients with active opioid misuse from May 21-July 31, 2018. We administered a survey to collect patients' demographic data, substance use history, and access to and use of NK. The primary outcome was NK access (prior receipt of a kit or prescription); secondary outcomes were knowledge and use of NK, and barriers to obtaining and using it. Results: Of 165 respondents, 71.5% knew of THN programs and 57.6% (n = 95) had access to THN by either having received a NK (n = 90) or a prescription (n = 5); 34 respondents received both. Among 39 (23.6%) who received a naloxone prescription, 25 (64.1%) filled it. 60.0% (n = 99) reported knowing how to administer naloxone; lack of training was the primary reason (n = 63/66, 96.9%) for their unfamiliarity. Patients who presented after an opioid overdose (25.5%; n = 42) were less likely to have knowledge of THN programs (57.1% vs. 76.4%), and to have received a NK (35.7% vs. 61.0%). Conclusion: Awareness of THN programs was high among our cohort. But approximately 60% the respondents received a NK or knew how to use it. Despite efforts to expand THN access, gaps in knowledge, access, and use exist.
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Affiliation(s)
- Brenten R Hurt
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Atizaz Hussain
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aledhaim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Siamak Moayedi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen M Schenkel
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hong K Kim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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